Recently, I spoke to a gathering of lawyers, insurance adjusters, and several of the Commissioners from the South Carolina Workers’ Compensation Commission on the topic of brain injuries at the South Carolina Workers Compensation Educational Association’s Medical Conference in Greenville, S.C.  There are numerous types of brain injuries that range from the most severe and totally debilitating, to milder injuries from which there is a quick recovery and no apparent permanent effects.  In my practice, we deal with numerous head/brain injury cases in workers compensation, as these injuries can happen in all types of work settings.

Types of Brain Injuries

The most common type of head/brain injuries we see are concussions (or mild traumatic brain injury).  These types of injuries occur most often when a person’s head hits a hard object (ex., a person’s head slamming against the floor after slipping in water).  These injuries can also occur from the brain shifting back and forth violently inside the skull (ex., when a person gets hit from behind in a motor vehicle accident and has whiplash).  This is known as a coup-contrecoup injury (See https://www.flintrehab.com/coup-contrecoup-brain-injuries/).

Mild traumatic brain injuries or concussions can lead to numerous symptoms:

(See https://www.cdc.gov/traumaticbraininjury/concussion/symptoms.html).

When symptoms of a mild traumatic brain injury last longer than expected after an injury (for a period of weeks or months), a person may be diagnosed with post-concussive syndrome. (See https://www.mayoclinic.org/diseases-conditions/post-concussion-syndrome/symptoms-causes/syc-20353352).  People can also develop post-traumatic headaches (or migraines), memory loss, tinnitus (ringing in the ears), or balance problems, the severity and frequency of which may require ongoing treatment.

The most serious type of brain injury is a severe or catastrophic brain injury.  Often these injuries involve a penetrating injury into the physical brain (ex., a bullet wound to the head), but a person can suffer a severe brain injury from closed-head trauma (no penetration into or gross deformity of the brain).  These injuries involve serious and usually permanent symptoms and deficits.

 Brain Injuries Under the South Carolina Workers’ Compensation Act

Typically, an injured worker is limited to a maximum of 500 weeks of benefits for a given injury (or injuries).  However, if a person suffers “physical brain damage,” defined as “physical brain damage that is both permanent and severe” (See Sparks v. Palmetto Hardwood, Inc., 406 S.C. 124, 131 (2013)), they may be entitled to lifetime benefits under the South Carolina Workers’ Compensation Act if they are no longer able to work in any capacity:

. . . [A]ny person determined to be totally and permanently disabled who as a result of a compensable injury is a paraplegic, a quadriplegic, or who has suffered physical brain damage is not subject to the five-hundred-week limitation and shall receive the benefits for life.

• 42-9-10(C) (emphasis added). These cases are complex and often require a great deal of work with treating doctors, medical experts, vocational experts, life care planners, etc. Frequently, people who suffer from physical brain damage will require care beyond their doctor’s visits.  This care is often provided by a family member, and the family member(s) providing such “attendant care” can be paid for their time as well.

For other brain injuries that are milder in nature and do not result in the inability to work, recovery is limited to permanent partial disability for the brain, which carries a minimum of 25 weeks of benefits up to a maximum of 250 weeks of benefits pursuant to S.C. Code Regs. 67-1101.  This does not necessarily mean that a person will no longer need medical treatment, as often times ongoing treatment is needed to maintain a person’s level of function.  While these types of injuries are often treated by neurologists, there are not many neurologists in South Carolina who will treat patients under Workers Compensation, so it can be a challenge to start and maintain treatment.  In fact, often times injured workers in the Upstate must travel to Columbia or Charleston for such treatment.

In some instances, a brain injury may combine with other injuries to render a person permanently and totally disabled (in which case benefits are taken out of 500 weeks minus any temporary payments that may have been made pursuant to § 42-9-10(A)).  Brain injuries may also combine with other injuries to result in a wage loss claim under § 42-9-20 when a person is able to work but cannot make the same wages they did prior to the injury because of their current disability.

Psychological Issues Related to Brain Injuries  

Sometimes people who suffered a brain injury will develop psychological issues either directly from the injury or by virtue of dealing with various issues caused by the brain injury.  For example, a person could develop “conversion disorder” following head trauma or brain injury, which involves neurological symptoms that can’t be explained by a neurological disease or other medical condition.

Signs and symptoms related to conversion disorder that affect body movement and function may include:

• Weakness or paralysis
• Abnormal movement, such as tremors or difficulty walking
• Loss of balance
• Difficulty swallowing or feeling “a lump in the throat”
• Seizures or episodes of shaking and apparent loss of consciousness (nonepileptic seizures)
• Episodes of unresponsiveness

Signs and symptoms of conversion disorder that affect the senses may include:

• Numbness or loss of the touch sensation
• Speech problems, such as the inability to speak or slurred speech
• Vision problems, such as double vision or blindness
• Hearing problems or deafness
• Cognitive difficulties involving memory and concentration

(See   https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197).

A person could also develop post traumatic stress disorder (“PTSD”) following a brain injury or anxiety/depression from not being able to think and function as they once could.  In these instances, a person may require treatment with a psychiatrist, psychologist, and/or counselor, and they may even benefit from medications or other therapies.

Treatment Process and Outcomes

Brain injuries can be very frustrating for injured workers.  These are not injuries that can be seen or felt, so there can be doubt and questions regarding their severity.  These injuries are also unpredictable in terms of how long it takes to recover and to what degree a person may recover.  These cases require a great deal of patience in that treating doctors may need to try different medications (or combinations of medications) or other treatment options to determine what will ultimately work best for a given person.

If you have suffered a head/brain injury as a result of an on-the-job accident, the sooner you can get help and guidance from an attorney, the better.  You can contact me for a free consultation on these types of injuries or any other work injuries.  Click on Jeremy A. Dantin – KD Trial Lawyers (spartanlaw.com) to find out more about me and my practice in workers compensation.  You may also reach me at (864)585-5100, or by email at jdantin@spartanlaw.com.